Screening for coeliac disease in 1624 mainly asymptomatic children with type 1 diabetes: is genotyping for coeliac-specific human leucocyte antigen the right approach?. Issue 4 (20th April 2019)

• Record Type: Journal Article
• Authors: Binder, Elisabeth; Rohrer, Tilmann; Denzer, Christian; Marg, Wolfgang; Ohlenschläger, Ute; Schenk-Huber, Heike; Schierloh, Ulrike; Skopnik, Heino; Fröhlich-Reiterer, Elke Elisabeth; Holl, Reinhard W; Prinz, Nicole
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 4(2019)
• Page Start: 354
• Publication Date: 2019-04-20
• Subjects: diabetes -- gastroenterology -- immunology -- screening -- paediatric practice; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2018-315549
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objectives: To investigate the frequency of coeliac disease (CD)-specific human leucocyte antigen (HLA) genotypes in paediatric patients with type 1 diabetes (T1D), who are known to have a higher prevalence of CD than the general population, and to evaluate whether HLA genotyping is a suitable first-line screening method for CD. Study design: The study was a multicentre observational analysis of patients with T1D aged <20 years of whom a subgroup had undergone HLA genotyping. Patient data were retrieved from the Diabetes Prospective Follow-up database, a large diabetes follow-up registry. The present analysis included data from 439 centres throughout Germany, Austria, Switzerland and Luxembourg. Results: In March 2017, the database contained 75 202 patients with T1D (53% male, mean age (SD) 14.6 (4.1) years, mean age at diagnosis 8.8 (4.3) years and mean diabetes duration 5.8 (4.3) years). 1624 patients had undergone coeliac-specific HLA genotyping, of whom 1344 (82.8%) were positive for HLA-DQ2, HLA-DQ8 or both, while 17.2% had no coeliac-specific HLA-markers. 26.6% of at-risk patients had a clinical suspected diagnosis of CD, and 3.6% had biopsy-proven CD. Conclusions: Genotyping for HLA-DQ2, HLA-DQ8 or both is positive in the vast majority (>80%) of patients with T1D. Therefore, screening for coeliac-specific HLA genotypes as a first-line test is not a suitable method to exclude CD in T1D. Regular screening for coeliac-specific antibodies in T1D is still recommended.